Browsing by Author "Cheng, Adam"
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Item Open Access A practical guide to virtual debriefings: communities of inquiry perspective(2020-08-12) Cheng, Adam; Kolbe, Michaela; Grant, Vincent; Eller, Susan; Hales, Roberta; Symon, Benjamin; Griswold, Sharon; Eppich, WalterAbstract Many simulation programs have recently shifted towards providing remote simulations with virtual debriefings. Virtual debriefings involve educators facilitating conversations through web-based videoconferencing platforms. Facilitating debriefings through a computer interface introduces a unique set of challenges. Educators require practical guidance to support meaningful virtual learning in the transition from in-person to virtual debriefings. The communities of inquiry conceptual framework offer a useful structure to organize practical guidance for conducting virtual debriefings. The communities of inquiry framework describe the three key elements—social presence, teaching presence, and cognitive presence—all of which contribute to the overall learning experience. In this paper, we (1) define the CoI framework and describe its three core elements, (2) highlight how virtual debriefings align with CoI, (3) anticipate barriers to effective virtual debriefings, and (4) share practical strategies to overcome these hurdles.Item Open Access Advanced neonatal procedural skills: a simulation-based workshop: impact and skill decay(2023-01-13) Stritzke, Amelie; Murthy, Prashanth; Fiedrich, Elsa; Assaad, Michael-Andrew; Howlett, Alexandra; Cheng, Adam; Vickers, David; Amin, HarishAbstract Background Trainees aiming to specialize in Neonatal Perinatal Medicine (NPM), must be competent in a wide range of procedural skills as per the Royal College of Canada. While common neonatal procedures are frequent in daily clinical practice with opportunity to acquire competence, there are substantial gaps in the acquisition of advanced neonatal procedural skills. With the advent of competency by design into NPM training, simulation offers a unique opportunity to acquire, practice and teach potentially life-saving procedural skills. Little is known on the effect of simulation training on different areas of competence, and on skill decay. Methods We designed a unique simulation-based 4-h workshop covering 6 advanced procedures chosen because of their rarity yet life-saving effect: chest tube insertion, defibrillation, exchange transfusion, intra-osseus (IO) access, ultrasound-guided paracentesis and pericardiocentesis. Direct observation of procedural skills (DOPS), self-perceived competence, comfort level and cognitive knowledge were measured before (1), directly after (2), for the same participants after 9–12 months (skill decay, 3), and directly after a second workshop (4) in a group of NPM and senior general pediatric volunteers. Results The DOPS for all six procedures combined for 23 participants increased from 3.83 to 4.59. Steepest DOPS increase pre versus post first workshop were seen for Defibrillation and chest tube insertion. Skill decay was evident for all procedures with largest decrease for Exchange Transfusion, followed by Pericardiocentesis, Defibrillation and Chest Tube. Self-perceived competence, comfort and cognitive knowledge increased for all six procedures over the four time points. Exchange Transfusion stood out without DOPS increase, largest skill decay and minimal impact on self-assessed competence and comfort. All skills were judged as better by the preceptor, compared to self-assessments. Conclusions The simulation-based intervention advanced procedural skills day increased preceptor-assessed directly observed procedural skills for all skills examined, except exchange transfusion. Skill decay affected these skills after 9–12 months. Chest tube insertions and Defibrillations may benefit from reminder sessions, Pericardiocentesis may suffice by teaching once. Trainees’ observed skills were better than their own assessment. The effect of a booster session was less than the first intervention, but the final scores were higher than pre-intervention. Trial Registration Not applicable, not a health care intervention.Item Open Access An experimental study on the impact of clinical interruptions on simulated trainee performances of central venous catheterization(2017-02-14) Jones, Jessica; Wilkins, Matthew; Caird, Jeff; Kaba, Alyshah; Cheng, Adam; Ma, Irene W YAbstract Background Interruptions are common in the healthcare setting. This experimental study compares the effects of interruptions on simulated performances of central venous catheterization during a highly versus minimally complex portion of the task. Methods Twenty-six residents were assigned to interruptions during tasks that are (1) highly complex: establishing ultrasound-guided venous access (experimental group, n = 15) or (2) minimally complex: skin cleansing (control group, n = 11). Primary outcomes were (a) performance scores at three time points measured with a validated checklist, (b) time spent on the respective tasks, and (c) number of attempts to establish venous access. Results Repeated measure analyses of variances of performance scores over time indicated no main effect of time or group. The interaction between time and group was significant: F (2, 44) = 4.28, p = 0.02, and partial eta2 = 0.16, indicating a large effect size. The experimental group scores decreased steadily over time, while the control group scores increased with time. The experimental group required longer to access the vein (148 s; interquartile range (IQR) 60 to 361 vs. 44 s; IQR 27 to 133 s; p = 0.034). Median number of attempts to establish venous access was higher in the experimental group (2, IQR 1–7 vs. 1, IQR 1–2; p = 0.03). Conclusions Interruptions during a highly complex task resulted in a consistent decrement in performance scores, longer time required to perform the task, and a higher number of venous access attempts than interruptions during a minimally complex tasks. We recommend avoiding interrupting trainees performing bedside procedures.Item Open Access Building impactful systems-focused simulations: integrating change and project management frameworks into the pre-work phase(2021-04-29) Dubé, Mirette; Posner, Glenn; Stone, Kimberly; White, Marjorie; Kaba, Alyshah; Bajaj, Komal; Cheng, Adam; Grant, Vincent; Huang, Simon; Reid, JenniferAbstract Healthcare organizations strive to deliver safe, high-quality, efficient care. These complex systems frequently harbor gaps, which if unmitigated, could result in harm. Systems-focused simulation (SFS) projects, which include systems-focused debriefing (SFD), if well designed and executed, can proactively and comprehensively identify gaps and test and improve systems, enabling institutions to improve safety and quality before patients and staff are placed at risk. The previously published systems-focused debriefing framework, Promoting Excellence and Reflective Learning in Simulation (PEARLS) for Systems Integration (PSI), describes a systematic approach to SFD. It includes an essential “pre-work” phase, encompassing evidence-informed steps that lead up to a SFD. Despite inclusion in the PSI framework, a detailed description of the pre-work phase, and how each component facilitates change management, was limited. The goal of this paper is to elucidate the PSI “Pre-work” phase, everything leading up to the systems-focused simulation and debriefing. It describes how the integration of project and change management principles ensures that a comprehensive collection of safety and quality issues are reliably identified and captured.Item Open Access Cognitive Load Theory for debriefing simulations: implications for faculty development(2018-12-29) Fraser, Kristin L; Meguerdichian, Michael J; Haws, Jolene T; Grant, Vincent J; Bajaj, Komal; Cheng, AdamAbstract The debriefing is an essential component of simulation-based training for healthcare professionals, but learning this complex skill can be challenging for simulation faculty. There are multiple competing priorities for a debriefer’s attention that can contribute to a high mental workload, which may adversely affect debriefer performance and consequently learner outcomes. In this paper, we conceptualize the debriefer as a learner of debriefing skills and we discuss Cognitive Load Theory to categorize the many potential mental loads that can affect the faculty debriefer as learner. We then discuss mitigation strategies that can be considered by faculty development programmes to enhance professional development of debriefing staff.Item Open Access Conducting multicenter research in healthcare simulation: Lessons learned from the INSPIRE network(2017-02-28) Cheng, Adam; Kessler, David; Mackinnon, Ralph; Chang, Todd P; Nadkarni, Vinay M; Hunt, Elizabeth A; Duval-Arnould, Jordan; Lin, Yiqun; Pusic, Martin; Auerbach, MarcAbstract Simulation-based research has grown substantially over the past two decades; however, relatively few published simulation studies are multicenter in nature. Multicenter research confers many distinct advantages over single-center studies, including larger sample sizes for more generalizable findings, sharing resources amongst collaborative sites, and promoting networking. Well-executed multicenter studies are more likely to improve provider performance and/or have a positive impact on patient outcomes. In this manuscript, we offer a step-by-step guide to conducting multicenter, simulation-based research based upon our collective experience with the International Network for Simulation-based Pediatric Innovation, Research and Education (INSPIRE). Like multicenter clinical research, simulation-based multicenter research can be divided into four distinct phases. Each phase has specific differences when applied to simulation research: (1) Planning phase, to define the research question, systematically review the literature, identify outcome measures, and conduct pilot studies to ensure feasibility and estimate power; (2) Project Development phase, when the primary investigator identifies collaborators, develops the protocol and research operations manual, prepares grant applications, obtains ethical approval and executes subsite contracts, registers the study in a clinical trial registry, forms a manuscript oversight committee, and conducts feasibility testing and data validation at each site; (3) Study Execution phase, involving recruitment and enrollment of subjects, clear communication and decision-making, quality assurance measures and data abstraction, validation, and analysis; and (4) Dissemination phase, where the research team shares results via conference presentations, publications, traditional media, social media, and implements strategies for translating results to practice. With this manuscript, we provide a guide to conducting quantitative multicenter research with a focus on simulation-specific issues.Item Open Access Distributed practice for cardiopulmonary resuscitation (CPR) training: improving educational efficiency and cost-effectiveness in clinical settings(2019-04-12) Lin, Yiqun; Hecker, Kent; Cheng, Adam; Grant, Vincent J.; Currie, Gillian R.Cardiac arrest is a major health problem; high-quality cardiopulmonary resuscitation (CPR) is one of the most important determinants of survival and survival with good neurological outcomes of the victims. Despite annual training, healthcare providers struggle to conduct guideline compliant CPR during the management of cardiac arrests. Increased likelihood of survival from cardiac arrest depends upon the integration of medical science, educational efficiency and local implementation (of science and education). There is some evidence to suggest that the use of distributed practice (i.e. separating the training into small portions dispersed over time) and real-time feedback (on compression depth, rate, and recoil) can improve CPR quality in healthcare providers and medical trainees. The aim of this research is to explore the efficacy and cost-effectiveness of distributed CPR training with real-time feedback relative to current CPR training practices. To accomplish this, the following work was completed: (1) designing a randomized trial to compare a new CPR training program incorporating workplace-based distributed CPR practice and real-time feedback with a group receiving conventional Heart and Stroke Foundation of Canada (HSFC) Basic Life Support (BLS) course; (2) describing the key components of, and approaches to economic evaluation in the context of simulation-based medical education; and (3) exploring the cost-effectiveness of distributed training program relative to conventional training to inform the decision whether or not to adopt the new CPR training program. This research shows that (1) workplace-based distributed CPR training significantly improves the acquisition and retention of CPR skills in practicing acute care providers and (2) this training method results in decreased training costs and increased learning outcomes in our local context. This research provides evidence to support the educational efficiency of distributed CPR training and informs the decision on implementation of this educational strategy by addressing the cost-effectiveness. Importantly, this research is the first study that comparing distributed CPR training with conventional training and longitudinally analyzing the CPR performance to address skill retention. Furthermore, this research represents the first economic evaluation studies in resuscitation training.Item Open Access Effects of Transcranial Direct-Current Stimulation on Motor Learning in the Developing Brain(2017) Ciechanski, Patrick; Kirton, Adam; Cheng, Adam; Johnston, Jamie; Teskey, CamTranscranial direct-current stimulation (tDCS) is a form of non-invasive brain stimulation applied in both healthy and clinical populations. Application of weak current induces electric fields at the neuronal level, and may lead to behavioral effects such as enhanced motor learning when paired with training. Nearly all investigations to date have been completed in the adult brain, and fundamental studies are lacking in pediatrics, yet are required to advance and optimize tDCS application in this population. Additionally, given the ability of tDCS to enhance motor learning, translation to complex motor skill acquisition is necessary to define the full potential of tDCS. Here we investigated the effects of tDCS on motor learning in healthy children, with subsequent probing of neurophysiological changes underlying these behavioral changes using transcranial magnetic stimulation. Next, we compared tDCS-induced electric fields in the child, adolescent, and adult brain, using computational current modeling. Given the therapeutic potential of tDCS in pediatrics, we examined the safety and feasibility of tDCS application in childhood stroke. Finally, we examined the effects of tDCS on complex motor skill acquisition, including laparoscopic surgical and neurosurgical skills in medical trainees. Our findings suggest that tDCS can safely enhance motor learning in healthy children and young adults. Neurophysiological mechanisms underlying these changes appear to be variable. Current modeling suggests that children are exposed to substantially stronger electric fields compared to adults, possibly contributing to the complex neurophysiological changes seen with tDCS application in children. Despite inducing stronger electric fields, application of tDCS appears to be safe in children and adolescents. tDCS-enhanced motor learning may not be restricted to basic motor skills, but complex laparoscopic surgical skills, and neurosurgical tumor resection skills may be sensitive to enhancement as well. In summary, our findings suggest that tDCS application is safe in the developing brain, and capable of producing robust behavioral changes. These findings support the translation of tDCS to pediatric therapeutic investigations. Neurophysiological mechanisms of these changes require further investigation. Establishing the ability of tDCS to enhance surgical skill acquisition may counteract the current short-comings of surgical training, revolutionizing the field of medical education.Item Open Access An experimental study on the impact of clinical interruptions on simulated trainee performances of central venous catheterization(BioMed Central, 2017-02) Jones, Jessica; Wilkins, Matthew; Caird, Jeff; Kaba, Alyshah; Cheng, Adam; Ma, IreneBackground: Interruptions are common in the healthcare setting. This experimental study compares the effects of interruptions on simulated performances of central venous catheterization during a highly versus minimally complex portion of the task. Methods: Twenty-six residents were assigned to interruptions during tasks that are (1) highly complex: establishing ultrasound-guided venous access (experimental group, n = 15) or (2) minimally complex: skin cleansing (control group, n = 11). Primary outcomes were (a) performance scores at three time points measured with a validated checklist, (b) time spent on the respective tasks, and (c) number of attempts to establish venous access. Results: Repeated measure analyses of variances of performance scores over time indicated no main effect of time or group. The interaction between time and group was significant: F (2, 44) = 4.28, p = 0.02, and partial eta2 = 0.16, indicating a large effect size. The experimental group scores decreased steadily over time, while the control group scores increased with time. The experimental group required longer to access the vein (148 s; interquartile range (IQR) 60 to 361 vs. 44 s; IQR 27 to 133 s; p = 0.034). Median number of attempts to establish venous access was higher in the experimental group (2, IQR 1–7 vs. 1, IQR 1–2; p = 0.03). Conclusions: Interruptions during a highly complex task resulted in a consistent decrement in performance scores, longer time required to perform the task, and a higher number of venous access attempts than interruptions during a minimally complex tasks. We recommend avoiding interrupting trainees performing bedside procedures.Item Open Access Impact of the PEARLS Healthcare Debriefing cognitive aid on facilitator cognitive load, workload, and debriefing quality: a pilot study(2022-12-12) Meguerdichian, Michael; Bajaj, Komal; Ivanhoe, Rachel; Lin, Yiqun; Sloma, Audrey; de Roche, Ariel; Altonen, Brian; Bentley, Suzanne; Cheng, Adam; Walker, KatieAbstract Background The Promoting Excellence and Reflective Learning in Simulation (PEARLS) Healthcare Debriefing Tool is a cognitive aid designed to deploy debriefing in a structured way. The tool has the potential to increase the facilitator’s ability to acquire debriefing skills, by breaking down the complexity of debriefing and thereby improving the quality of a novice facilitator’s debrief. In this pilot study, we aimed to evaluate the impact of the tool on facilitators’ cognitive load, workload, and debriefing quality. Methods Fourteen fellows from the New York City Health + Hospitals Simulation Fellowship, novice to the PEARLS Healthcare Debriefing Tool, were randomized to two groups of 7. The intervention group was equipped with the cognitive aid while the control group did not use the tool. Both groups had undergone an 8-h debriefing course. The two groups performed debriefings of 3 videoed simulated events and rated the cognitive load and workload of their experience using the Paas-Merriënboer scale and the raw National Aeronautics and Space Administration task load index (NASA-TLX), respectively. The debriefing performances were then rated using the Debriefing Assessment for Simulation in Healthcare (DASH) for debriefing quality. Measures of cognitive load were measured as Paas-Merriënboer scale and compared using Wilcoxon rank-sum tests. Measures of workload and debriefing quality were analyzed using mixed-effect linear regression models. Results Those who used the tool had significantly lower median scores in cognitive load in 2 out of the 3 debriefings (median score with tool vs no tool: scenario A 6 vs 6, p=0.1331; scenario B: 5 vs 6, p=0.043; and scenario C: 5 vs 7, p=0.031). No difference was detected in the tool effectiveness in decreasing composite score of workload demands (mean difference in average NASA-TLX −4.5, 95%CI −16.5 to 7.0, p=0.456) or improving composite scores of debriefing qualities (mean difference in DASH 2.4, 95%CI −3.4 to 8.1, p=0.436). Conclusions The PEARLS Healthcare Debriefing Tool may serve as an educational adjunct for debriefing skill acquisition. The use of a debriefing cognitive aid may decrease the cognitive load of debriefing but did not suggest an impact on the workload or quality of debriefing in novice debriefers. Further research is recommended to study the efficacy of the cognitive aid beyond this pilot; however, the design of this research may serve as a model for future exploration of the quality of debriefing.Item Open Access Reducing the impact of intensive care unit mattress compressibility during CPR: a simulation-based study(2017-11-16) Lin, Yiqun; Wan, Brandi; Belanger, Claudia; Hecker, Kent; Gilfoyle, Elaine; Davidson, Jennifer; Cheng, AdamAbstract Background The depth of chest compression (CC) during cardiac arrest is associated with patient survival and good neurological outcomes. Previous studies showed that mattress compression can alter the amount of CCs given with adequate depth. We aim to quantify the amount of mattress compressibility on two types of ICU mattresses and explore the effect of memory foam mattress use and a backboard on mattress compression depth and effect of feedback source on effective compression depth. Methods The study utilizes a cross-sectional self-control study design. Participants working in the pediatric intensive care unit (PICU) performed 1 min of CC on a manikin in each of the following four conditions: (i) typical ICU mattress; (ii) typical ICU mattress with a CPR backboard; (iii) memory foam ICU mattress; and (iv) memory foam ICU mattress with a CPR backboard, using two different sources of real-time feedback: (a) external accelerometer sensor device measuring total compression depth and (b) internal light sensor measuring effective compression depth only. CPR quality was concurrently measured by these two devices. The differences of the two measures (mattress compression depth) were summarized and compared using multilevel linear regression models. Effective compression depths with different sources of feedback were compared with a multilevel linear regression model. Results The mean mattress compression depth varied from 24.6 to 47.7 mm, with percentage of depletion from 31.2 to 47.5%. Both use of memory foam mattress (mean difference, MD 11.7 mm, 95%CI 4.8–18.5 mm) and use of backboard (MD 11.6 mm, 95% CI 9.0–14.3 mm) significantly minimized the mattress compressibility. Use of internal light sensor as source of feedback improved effective CC depth by 7–14 mm, compared with external accelerometer sensor. Conclusion Use of a memory foam mattress and CPR backboard minimizes mattress compressibility, but depletion of compression depth is still substantial. A feedback device measuring sternum-to-spine displacement can significantly improve effective compression depth on a mattress. Trial registration Not applicable. This is a mannequin-based simulation research.Item Open Access Team Adaptation in High Reliability Teams(2020-06-17) Deacon, Amanda; O'Neill, Thomas A.; Gilfoyle, Elaine; Caird, Jeffrey K.; MacInnis, Cara C.; Cheng, Adam; Grossman, RebeccaThis research attempts to identify key components of adaptation in high reliability teams, with the goal being error reduction. The current literature is limited in its lack of empirical evidence showing how these models may differ based upon specific characteristics of high reliability teams. This topic is explored through three separate studies using resuscitation teams faced with family presence as a representation of a high reliability team requiring adaptation. Our first study sought to cultivate deeper understanding of the trigger and how it may potentially affect a team via a scoping study of family presence. The second study used qualitative analysis of debriefs with the sample population to identify key processes of successful team adaptation. In our third study, we used a mixed methods approach to test and provide evidence for the existence of the key processes and states identified in the second study. How this evidence contributes to our understanding of team adaptation in high reliability teams is discussed in the final chapter. Our findings indicate that high reliability teams differ from the standard team during the adaptation process and this may impact how we should approach training these teams.